Does Insurance Cover STD Testing?

Insurance often pays for STD testing, but not always, and not for every test. The answer turns on which test it is, why it was ordered and whether the provider is in your network.

Does insurance cover STD testing?

Healthcare.gov says most health plans must cover a set of preventive services, like screening tests, at no cost to you. Generally, these services are covered at no cost when provided by an in-network medical provider. It adds that $0 cost isn’t guaranteed in all cases.

Screening means tests done when you have no symptoms. Healthcare.gov’s glossary defines screening as tests or exams to detect the presence of something, usually performed when you have no symptoms. A diagnostic test is one to figure out what your health problem is. Plans can treat the two differently, so ask how yours bills the test you want.

Which STD tests are covered at no cost?

Healthcare.gov’s list of preventive benefits for adults includes:

• HIV screening for everyone 15 to 65, and other ages at increased risk
• Hepatitis C screening for adults 18 to 79
• Hepatitis B screening for people at high risk
• Syphilis screening for adults at higher risk
• STI prevention counseling for adults at higher risk
• PrEP for HIV-negative adults at high risk of getting HIV through sex or injection drug use

Its list for women also names chlamydia screening for younger women and other women at higher risk, gonorrhea screening for all women at higher risk, and syphilis and hepatitis B screening for pregnant women. This lines up with the USPSTF, which recommends chlamydia and gonorrhea screening for sexually active women 24 or younger, and for women 25 or older at increased risk.

What about men, and what about herpes?

The adult list doesn’t name chlamydia or gonorrhea screening. The USPSTF rated the evidence for screening men as insufficient, so coverage for men without symptoms may be less clear-cut. Call your plan.

The CDC doesn’t recommend routine herpes screening for the general population. A herpes blood test is therefore less likely to be on a no-cost preventive list, though your plan may still cover it for other reasons. Ask.

Why might I still get a bill?

• Out-of-network provider. The no-cost rule applies to in-network providers.
• The test isn’t on the preventive list for you. Age, sex and risk decide this.
• The test is billed as diagnostic. That can mean a copay or deductible. Healthcare.gov defines a copayment as a fixed amount you pay for a covered service, and a deductible as an amount you may owe before your plan starts paying.
• Other charges. The visit itself may carry a copay, separate from the test.

What should I ask my insurance company?

Call the number on your card, or ask the clinic’s billing desk, and ask:

1. Is this test covered as preventive screening for me, at no cost?
2. Is this clinic or lab in my network?
3. Will I owe a copay, or does the deductible apply?

Does insurance cover online or at-home STD tests?

Usually not. STDCheck says “To protect your privacy, we do not accept health insurance.” Quest Health says it does not bill insurance, and purchases cannot be submitted for insurance reimbursement. STDCheck lists HSA and FSA accounts among its payment options. Check the site of any service you are considering.

Can I get tested without using my insurance?

Yes. Using insurance means a claim goes to your plan. If you’d rather keep a test off that paperwork, you can pay directly at an online lab, which says it won’t send results to insurers. STDCheck, for example, says results are not put into your permanent medical file or sent to any insurance company.

You can also use a low-cost clinic. The HHS Office of Population Affairs says Title X services are voluntary, confidential and provided regardless of ability to pay, and that low-income clients may pay nothing or pay on a sliding scale.